surgoncoКреативная хирургия и онкологияCreative surgery and oncology2076-30932307-0501Башкирский государственный медицинский университет10.24060/2076-3093-2021-11-3-220-227surgonco-603Research ArticleОБЗОР ЛИТЕРАТУРЫREVIEWSХирургическое лечение рака молочной железы. Историческое развитие и современная картина (обзор литературы)Breast Cancer Surgery, History and Current State: a Literature Reviewhttps://orcid.org/0000-0002-9311-4749КаширинаЕ. П.KashirinaE. P.

Каширина Елена Павловна – кафедра факультетской хирургии № 1

Москва

Elena P. Kashirina – Department of Faculty Surgery No. 1

Moscow

dr.kashirina@mail.ruhttps://orcid.org/0000-0002-3904-6415КомаровР. Н.KomarovR. N.

Комаров Роман Николаевич – д.м.н., профессор, кафедра сердечно-сосудистой хирургии и инвазивной кардиологии, отделение хирургии аорты Клиники аортальной и сердечно-сосудистой хирургии

Москва

Roman N. Komarov – Dr. Sci. (Med.), Prof., Department of Cardiovascular Surgery and Invasive Cardiology; Aortic Surgery Unit, Aortic and Cardiac Surgery Clinic

Moscow

https://orcid.org/0000-0001-6099-1801ВычужанинД. В.VychuzhaninD. V.

Вычужанин Дмитрий Викторович – к.м.н., хирургическое абдоминальное отделение Клинического центра им. И.М. Сеченова

Москва

Dmitriy V. Vychuzhanin – Cand. Sci. (Med.), Department of Abdominal Surgery, Sechenov Clinical Centre

Moscow

Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian Federation202101102021113220227Copyright © Каширина Е.П., Комаров Р.Н., Вычужанин Д.В., 20212021Каширина Е.П., Комаров Р.Н., Вычужанин Д.В.Kashirina E.P., Komarov R.N., Vychuzhanin D.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surgonco.ru/jour/article/view/603

Грудь является символом женственности, сексуальности и материнства. Размер и форма молочных желез сказываются на самооценке женщины, на ее социальной активности. Хирургическое лечение злокачественных заболеваний молочных желез затрагивает медицинский, психологический, социальный, сексуальный аспекты жизни. Хирургическое лечение рака молочной железы начало свое развитие в 1600 году до нашей эры. Большим шагом в лечении молочной железы стала операция, предложенная в 1891–1894 годах W. Halsted и W. Meyer. В 1948 году D. Patey и W. Dyson предложили модифицированный вариант радикальной мастэктомии. Тенденция на сохранение тканей способствовала поиску хирургами более совершенных методов. С 1990-х годов модифицированный вариант операции J. Madden стал стандартом при лечении рака молочной железы независимо от стадии заболевания. Совершенствование методов массового первичного обследования привело к улучшению ранней диагностики рака молочной железы и обнаружению опухолевого процесса на начальных стадиях, что также повлияло на определение тактики хирургического лечения. В 1970–1980-е годы U. Veronesi предложил вариант органосохраняющей операции, состоящей из квадрантэктомии с подмышечной лимфодиссекцией трех уровней с проведением лучевой терапии. Данное сочетание способствовало получению лучших косметических результатов без нарушения радикализма лечения. Необходимость соблюдения принципов радикальности лечения и получения более эстетичных результатов способствовала интеграции в онкологический процесс элементов пластической хирургии, а также развитию реконструктивно-пластических операций на молочной железе. Начался новый виток развития хирургического лечения рака молочной железы. Онкопластическая хирургия признана безопасной, способствует улучшению косметических результатов, оказывает влияние на психологическую и социальную адаптацию больных. В настоящее время существует множество вариантов хирургического лечения рака молочной железы, отмечается тенденция к максимальному сохранению тканей.

Breasts symbolise femininity, sexuality and motherhood. The breast size and shape affect the woman’s self-esteem and social activity. Surgical treatment of malignant breast diseases concerns the medical, psychological, social and sexual aspects of life. Surgery for breast cancer dawns back to 1,600 B.C., with a milestone operation of radical mastectomy proposed in 1891–1894 by W. Halsted and W. Meyer and modified by D. Patey and W. Dyson in 1948. Tissue preservation has shaped a trend towards improving the technique. Since the 1990s, the modified J. Madden’s operation has become the treatment standard in breast cancer, irregardless of stage. The improvement of mass first-visit check-up advanced early diagnosis of initial breast tumourisation, which also influenced the choice of surgical tactics. U. Veronesi proposed a variant of organ-preserving surgery in 1970–80s involving three-level axillary lymph node dissection quadrantectomy, followed by radiotherapy. This combination facilitated aesthetic results at no compromise of radicality of the treatment. The need to observe radicality and sustain aesthetics contributed to the integration of plastic surgery into oncological cure and emergence of reconstructive and plastic breast surgery. The field has entered new cycle. Oncoplastic surgery is recognised safe, improves aesthetics and gives a salutary impact on psychological and social adjustment. Manifold surgical options in breast cancer coexist and develop towards maximal tissue preservation.

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The authors declare that there are no conflicts of interest present.